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The convergence of the biologic and psychodynamic arenas relevant to aging have ramifications for research, services, and aging policy. A few models pertaining to mental health aspects of physical health and illness in the elderly are given. Related research is noted and case examples illustrate the dynamic interplay between mental and physical factors.
The authors examined models of the relationships between religious activities, physical health, social support, and depressive symptoms in a sample of 4,000 persons age 65 and over. Religious activity was examined first as a single composite construct and then split into three component variables that were examined individually. Religious activity as a single construct was correlated with both social support and good physical health but was unrelated to depression. Split into the three components, model fit was significantly increased. Frequency of church attendance was positively related to physical health and negatively related to depression, but was surprisingly unrelated to social support. Frequent churchgoers were about half as likely to be depressed. Private prayer/Bible reading was negatively correlated with physical health and positively correlated with social support, but unrelated to depression. Religious TV/radio listening was unrelated to social support, negatively related to good physical health, and, unexpectedly, positively associated with depression.
BACKGROUND: In later life, declining physical health is often thought to be one of the most important risk factors for depression. Major depressive disorders are relatively rare, while depressive syndromes which do not fulfill diagnostic criteria (minor depression) are common. METHODS: Community-based sample of older adults (55-85) in the Netherlands: baseline sample n = 3056; study sample in two stage screening procedure n = 646. Both relative (odds ratios) and absolute (population attributable risks) measures of associations reported. RESULTS: In multivariate analyses minor depression was related to physical health, while major depression was not. General aspects of physical health had stronger associations with depression than specific disease categories. Significant interactions between ill health and social support were found only for minor depression. Major depression was associated with variables reflecting long-standing vulnerability. CONCLUSION: Major and minor depression differ in their association with physical health. LIMITATION: Cross-sectional study relying largely on self-reported data. CLINICAL RELEVANCE: In major depression, with or without somatic co-morbidity, primary treatment of the affective disorder should not be delayed. In minor depression associated with declining physical health, intervention may be aimed at either or both conditions.
This study tested the associations between acculturation and mental and physical health among Hispanic Vietnam veterans. Secondary data analyses of the National Vietnam Veterans Readjustment Survey, an epidemiological study of a representative sample of veterans who served during the Vietnam era (N = 1,195), were conducted. An acculturation index was constructed using standard acculturation measures (range, 0-13), and its predictive validity was tested using nine outcome measures of physical health and eight measures of mental health. Among Puerto Rican and Mexican-American veterans, the scores on the acculturation index ranged from 0 to 12. Hispanic veterans were distributed across the acculturation continuum as follows: 0 to 3 (24%), 4 to 7 (59%), 8 to 12 (17%). The acculturation scores were not associated with mental or physical health risks for Hispanic veterans. Mexican Americans and Puerto Ricans did not differ in mental or physical health risk compared with non-Hispanic whites. The association between acculturation and mental and physical health among Hispanics may not be generalized to Hispanic veterans. Hispanics who have been through an intensive assimilating experience, such as being in the military, appear to have health outcomes similar to whites.
BACKGROUND: Associations between physical health and depression are consistent across cultures among adults up to 65 years of age. In later life, the impact of physical health on depression is much more substantial and may depend on sociocultural factors. AIMS: To examine cross-national differences in the association between physical health and depressive symptoms in elderly people across western Europe. METHOD: Fourteen community-based studies on depression in later life in nine western European countries contributed to a total study sample of 22 570 respondents aged 65 years and older. Measures were harmonized for depressive symptoms (EURO-D scale), functional limitations and chronic physical conditions. RESULTS: In the majority of the participating samples, the association of depressive symptoms with functional disability was stronger than with chronic physical conditions. Associations were slightly more pronounced in the UK and Ireland. CONCLUSIONS: The association between physical health and depressive symptoms in later life is consistent across western Europe.
OBJECTIVE: To review research on prenatal influences on adult mental and physical health and draw implications for future directions in psychiatric research. METHOD: Schizophrenia is selected as an example from mental health and cardiovascular disease as an example from physical health. For each of these disorders, empirical findings on prenatal influences are reviewed, and the methods used to demonstrate them are critiqued. RESULTS: Research on prenatal antecedents of these conditions has proceeded in parallel: intriguing findings have related fetal growth restriction or fetal insult to adult health; similar types of causal pathways have been proposed to explain the relationships; and research has been plagued by similar limitations, including lack of precise prenatal exposure data and difficulty of controlling confounding. The prevailing view of disease causation, which is not well-suited to investigation of prenatal antecedents, impedes research in both fields. Yet, there has been little interchange between researchers in the 2 fields. CONCLUSIONS: We propose a causal paradigm that could serve as a guide for future investigations on the prenatal antecedents of adult health and promote interchange between research on mental and physical health. The paradigm reflects current thinking in epidemiology by encompassing not only risk factors as traditionally conceived but also causal chains over time and causal influences at multiple levels of organization. Implications for the design of new research are illustrated with reference to an ongoing study.
This study examined posttraumatic stress disorder (PTSD) symptoms, coping, and physical health status in students reporting a trauma history (N = 138) using structural equation modeling. Participants completed questionnaires assessing PTSD symptoms, coping specific to health-related and trauma-related stressors and physical health. After accounting for coping with health-specific problems, trauma-specific avoidance coping was uniquely associated with poorer health status. Posttraumatic stress disorder symptoms were associated with poorer physical health status, controlling for age, health behaviors, and other psychopathology. In addition, the effect of PTSD symptoms on poorer health status was mediated by health- and trauma-specific avoidance coping. Results suggest that university health centers should screen for PTSD and consider psychoeducational programs and coping skills interventions for survivors of trauma.
The Fitness-Performance Tests developed in 1965 by the Canadian Association for Health, Physical Education and Recreation have been criticized with regard to the validity of the 300 yard run as an endurance measure and with regard to the redundance of some items involving lower limb performance. The purposes of this study were to identify a more appropriate endurance performance test item and to analyze the inter-dependence of the items which utilize leg power in their performance. A sample of 9000 young Canadians aged 6 to 17 years, was randomly selected from the 10 provinces and the 2 territories. Correlation coefficients were calculated between: standing long jump, the 50 m. run, and the endurance run (800 m. for 6-9 years, 1600 m. for 10-12 years and 2400 m. for 13-17 years). Among the different age and sex groups, the correlations between the endurance run and the 50 m. run varied from 0.40 to 0.49. The correlations between standing long jump, the agility run (4 x 10 m.) and the 50 m. run were from 0.69 to 0.83 for all the boys and girls. The correlations between these three items are even lower when performances are analyzed by age and sex groups. The highest variations are mainly in the preadolescent period for both sexes.
OBJECTIVE: To investigate the response of residential homes to four specific health problems of residents and the relationship between the quality of this response and the prevalence of depression. DESIGN AND SAMPLE: Post hoc analysis of data collected for a cross-sectional survey of homes chosen to represent "excellent" and "standard" care; resident sample sufficient to detect difference between 20% and 40% depression prevalence between two groups of homes (90% power, 5% significance). Three hundred and nine residents were assessed. SETTING: Seventeen residential homes in different areas of England. METHODS: Data were collected about aspects of the care provided, including quality rating of care plans. Standard instruments were used to collect resident data by direct and informant interviews, including assessments of dementia, depression, dependency, medication and specific health problems. RESULTS: Seventy-nine per cent of the sample were suffering from dementia; 40% of 194 residents who could be assessed for depression were depressed. Of residents assessed by research nurses, 72% had problems with mobility, 67% with stability, 40% with hearing and 46% with vision. Quality of response to these problems was variable. In a combined assessment of care plan quality and key worker awareness, 7% of homes' responses to these four problems in residents were rated as good. Seventeen per cent of depressed residents were so identified by their key workers. Good interventions by key workers were associated with less depression in residents. DISCUSSION: The response of home staff and community health professionals to physical health needs in residential homes is variable and should be improved. This study suggests that improving this aspect of care provision might reduce depression and thus improve quality of life.
This study examined social cognitive and physical health factors that might explain variations in exercise adherence in a 3-month supervised exercise intervention for a group of mildly symptomatic, HIV-1 seropositive men and women. The social cognitive predictor variables were outcome expectations and self-efficacy. The physical health predictor variables included CD4+ cell counts, self-report inventories of physical symptoms, and physicians' examinations. Self-report inventories of physical symptoms were associated with physicians' examinations and combined into a composite measure of physical health. Criterion variables included exercise adherence rates, VO2max change, and status as a 'remainder' versus 'drop-out.' The composite measure of physical health emerged as a significant predictor of adherence rate and gave perfect prediction of remainers and a moderate prediction of dropouts. No significant associations were observed between the social cognitive predictors and adherence. Results suggest that for this population physical health status is a better predictor of exercise adherence than either perceived self-efficacy or outcome expectancy.
Traumatic event exposure and physical health were examined in a community-residing sample of 1,500 New Zealand adults. Half (51%) reported past traumatic event exposure, 9% reported recent (past 12 months) trauma exposure, and 40% reported no exposure. After adjusting for gender, ethnic, and age differences, those experiencing crime and accident trauma exhibited significantly deteriorated physical health, as measured by current physical symptoms, chronic medical conditions, and chronic limitations in daily functioning. Further research is required to assess the influence of traumatic events on the physical health among adults from other countries, and to evaluate the factors that may mediate or moderate this relationship for different subgroups of the New Zealand population. Limitations of this study are outlined.
Preplanning and organization can facilitate the health physics response in the event of a medical radiation emergency. Anticipating the needs will allow for advanced assembly of needed information and supplies that would be useful in effectively responding to such events. Annual training of emergency care providers and an easy to read and understand poster will be of great benefit in guiding personnel until health physics arrives. Major events also need consideration, in advance, as they will place additional demands on health physics.
The relationship between preventative physical health care and mental health in individuals with schizophrenia was assessed retrospectively by questionnaires completed by 504 caregivers. Psychiatric symptom severity and quality-of-life data on 332 respondents were evaluable. Suboptimal preventative physical health care was defined as absence of > or =2 examinations within a specified time: physical and dental within 12 months, eye within 24 months. Findings revealed similar use of mental health care services for all individuals, but those in the suboptimal physical health care group (n = 93 [28%]) had a lower quality of life (p < .011), more negative symptoms (p < .009), less paid employment (p < .001), and more alcohol/drug abuse (p = .02). These findings suggest that mental health care providers should play a more active role in monitoring the basic physical health care of patients with schizophrenia.
BACKGROUND: The World Health Organisation Disability Assessment Schedule II (WHODAS II) measures functioning and disability in concordance with the bio-psycho-social model of the WHO's International Classification of Functioning, Disability, and Health. Our objectives were to investigate the independent associations of physical health, depression and cognitive function with WHODAS II disability in an older Korean population. METHODS: The WHODAS II was administered to a community sample of 1204 residents age 65 or over. Data on demographic characteristics (age, gender, living area, marital state, and religion), socio-economic state (education, type of accommodation, number of rooms, previous occupation, current employment, monthly income), social support, number of physical illness, depression (GMS), and cognitive function (MMSE) was gathered. A subsample (n = 746) received a clinical examination for dementia. RESULTS: Scores on the WHODAS II were significantly and independently associated with worse physical health, depression, and lower cognitive function. Associations with other factors were no longer apparent after adjustment for these. These associations persisted in the absence of dementia. In participants with dementia (n = 110), WHODAS II scores were principally associated with physical health and accommodation type. CONCLUSIONS: Level of disability, as measured by the WHODAS II, was principally associated with physical health, depression and cognitive function, rather than socio-demographic factors.
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BACKGROUND: The physical health correlates of mild cognitive impairment (MCI) in the older individual are poorly known. The aim of this study was to investigate the relationship between physical health and MCI with population data. METHODS: Subjects were 1,435 nondemented 75- to 95-year-old subjects. MCI was defined as scoring one standard deviation below age- and education-specific means on the Mini-Mental State Examination. MCI was consistently associated with indicators of poorer health in logistic regression models with adjustment for potential confounders. RESULTS: The adjusted odds ratios for those with two, three, four, or more somatic symptoms compared with those with one or no symptoms were 1.3 (95% confidence intervals 1.0 to 1.9) and 2.1 (1.2 to 4.5; p for trend =.004); for those with poor self-rated health the odds ratio was 1.9 (1.4 to 2.6); for those with one, two, or more chronic diseases compared with those with no chronic diseases, the odds ratios were 1.3 (0.9 to 1.9) and 3.0 (1.2 to 7.6; p for trend =.02); and for those dying during the 3-year follow-up period the odds ratio was 1.5 (1.1 to 2.2). CONCLUSIONS: MCI is associated with poor physical health, leading to the hypothesis of a causal relationship between physical diseases and MCI in older populations.
OBJECTIVE: To determine the contributions of psychological trauma (exposure to combat during the Vietnam War), genetic factors, childhood experiences shared by twin siblings, and unmeasured experiences not shared by twin siblings to the reporting of current physical health problems a mean of 19 years after military service. METHODS: In 1987, a national sample of 2224 monozygotic and 1818 dizygotic male veteran members of the Vietnam Era Twin Registry participated in a survey of health. Genetic modeling was performed on cross-sectional physical health and combat exposure data derived from Registry twins. RESULTS: Combat experiences explained a small proportion (0.7-8.4%) of the variance in the report of hypertension, respiratory conditions, persistent skin conditions, gastrointestinal disorders, joint disorders, and hearing problems. Childhood experiences shared by siblings are not clearly related to any health problem studied. By contrast, genetic factors explain 31 to 54% and noncombat experiences not shared by siblings explain 45 to 66% of the variance in current physical health status. CONCLUSIONS: Greater than 90% of the variance in reported current physical health problems in Vietnam era veterans is attributable to inherited factors and unmeasured environmental experiences not shared by twin siblings. The traumatic experience of combat makes only a small contribution to the report of current physical health problems. These results do not preclude the possibility that combat influenced the prevalence of illness shortly after military service or that combat may influence the development of illness in the future.
The relationship between current mental and physical health and history of education, marriage, child-rearing and employment was studied in 541 women aged 42-50. Participants, recruited from the community for a longitudinal study of risk factors for cardiovascular disease, were all premenopausal and free from major diagnosed physical or mental disorder. Physical health measures included weight, cigarette and alcohol consumption, and current physical symptoms. Self-report psychological measures included depression, anxiety, anger, stress, and coping. Women who were mothers and still in their first marriage ("married with children") were somewhat healthier and happier than others. However, women with only a high school education, even when "married with children," were at a fourfold risk of depression compared with college-educated women, unless they were in paid employment, in which case their risk was not increased. Employment did not affect the risk of depression for college-educated women who were "married with children." Among other women, lack of paid employment more than doubled the risk of depression, whatever the educational level. Among the measures of physical health, the only significant finding was a high rate of smoking among high-school-educated women not in traditional marriages. Possible pathways linking education, marital history and current mental health are discussed.